UU Wellspring:Creating Meaning Registration

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This form cannot be submitted until an administrator completes the setup process to receive online payments.

Guardian Information

Guardian's Name

*

Guardian's Email

*

This address will receive a confirmation email

Guardian's Mobile Phone

*

Child Information

Name

*

Pronouns

*

Please select one option.

He/him/his She/her/hers They/them/theirs Other

Birthday

*

Grade

Please select one option.

Pre-K Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12

Allergies

*

Email

Mobile Phone

Pemissions

PHOTO RELEASE: I authorize MORRISTOWN UNITARIAN UNIVERSALIST FELLOWSHIP to use my child’s photo, without charge, for promotional purposes in its publications, advertising, web site, or other formats.

*

Please select one option.

Yes No

MEDICAL RELEASE: I hereby give permission for a doctor, nurse, and/or other qualified medical personnel to treat my child in case of emergency.

*

Please select one option.

Yes No

UPDATED RECORDS: I hereby attest that the record provided about my child (Emergency Contact, Allergies, Medical Information etc.) are up to date in our online management software.

*

Please select one option.

Yes No

Payment $10

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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